Posterior screw fixation in rotationally unstable pelvic ring injuries.

OBJECTIVE: Although the stability of the pelvic ring primarily depends on the integrity of the posterior sacroiliac arch, lateral compression fractures with rotational instability are commonly treated by anterior fixation alone. The objective of the present study was to assess the outcome of patients with these fractures treated by posterior iliosacral screw fixation alone.

METHODS: Patients with rotationally unstable lateral compression fractures of the pelvic ring (Young and Burgess LC I and LC II or AO/Tile B2) treated by percutaneous iliosacral fixation alone were included. Postoperative complications, need for secondary surgery, malunion, secondary fracture displacement and the time to full-weight bearing were documented.

RESULTS: Twenty-five patients (13 female, 26 male; age: 56±20 years) were treated by percutaneous screw fixation (14 bilaterally, 11 unilaterally). Mean follow-up was 6±4 months, mean time to full weight bearing 9±3 weeks. Revision surgery was necessary in two patients (8%) due to nerve irritation; an additional anterior stabilisation was needed in two other patients (8%) due to secondary dislocation. Wound infection or motor weakness were not encountered, non-union of the posterior arch did not occur. Non-union of the pubic rami, however, occurred in two patients. The presence of malunion of the pubic rami did not affect the time to full weight bearing.

CONCLUSIONS: Percutanous iliosacral screw fixation alone is a sufficient technique for the stabilisation of rotationally unstable pelvic fractures with low rates of complications or non-unions. It allows for a minimally invasive treatment thus being a useful option in patients who do not qualify for open anterior fixation.